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Avatar universal

confusion regarding cath result

I had a cath done 5 months after getting stent for cto of lad and another One month ago w/ ultrasound that said there was a 20% restenosis in stent on report. I got the disc and took to top guy to review and he said stent was wide open ie, no stenosis. How can something that would appear to be cut and dry objective observation be so differently interpreted especially since cath report is rather specific about the appearance of the lesion eg, smooth, irregular. I get so flustered that I walk out w/ more ?s than answers and it is impossible to get these people on the phone to clarify. They get most annoyed when it is they who are the problem.
28 Responses
976897 tn?1379171202
Heart attack seems to mean different things to different people and so I think we should agree on a definition before I answer. I have even been under different Cardiologists who use the term to mean different things. Technically and medically, heart attack means myocardial infarction. This is when the blood supply to a part of the heart muscle is completely cut off and the muscle starts to die, never to be revived again. Some people refer to very bad symptoms (Angina) as having a heart attack, because the heart is under attack but the blood supply is not cut off totally. With a 99% blockage it can feel very nasty. All my experiences have been with the latter. When I have been to hospital (three times with severe angina), they have always found my troponin marker to be high and said "you are having a heart attack". When I ask "do you really mean a heart attack or am I suffering severe angina without 100% blockage" they just give me a blank look as if to say "idiot" and walk off. I was put on beta blockers after my first episode in 2007 and it was to rest my heart, to allow stunned cells to recover.
976897 tn?1379171202
So you basically have 3 sets of images? One shows the original artery before intervention, one shows immediate results after intervention and the third shows the condition of the artery now. If you took the latest images for a second opinion, then you will not get such an accurate assessment. Even if you took all 3 sets and the cardiologist only looked at the latest, he is likely to be wrong. With techniques today they tend to make the artery slightly wider where the stent is situated. So there would have been a narrowing on the first set of images, and the second set would show the artery in that area slightly wider than it normally would be. Now the third set may show that area as the same diameter as the rest of the artery, giving the opinion that there is no narrowing. Unless you match the images, you can't tell. If you have the images yourself, take a look at the stent and see if there's a difference between post procedure and now.
63984 tn?1385441539
I'm confused about the sequence of tests.  Was the original cath done at the same time that the stent was inserted?  That is the usual procedure/timeline.  Regarding the ultrasound, that isn't a usual test to determine restenosis of heart arteries, it is usually used to clarify valve and heart chamber health/condition.  

Regardless, a 20% restenosis is pretty minor, but a clear indication that a cardiac diet plus exercise and other caveats be observed.  Keep us informed.  
976897 tn?1379171202
I assumed the echo was done the same day as the last angiogram
Avatar universal
thanks for replies. was a little tired when I posted so to clarify  got the stent at first cath 100% calcified occlusion mid-lad 5 months ago. One month ago thought I was having a problem and went to er and they did another, this time they also did an intravascular ultrasound to get the most detailed view possible of stent etc... In recovery Dr. said all looked ok. as a formality a couple weeks after I got a copy of the report saying there was a 20% stenosis of the stented segment and described the lesion as smooth and irregular. As a layman this concerned me b/c if it goes from 0 to 20 in a few months, will it continue to progress or is this normal? the Dr. who did this cath did not take my insurance out of the er scenario and couldn't get him on phone so I had the disk sent to a 'top' guy other than the guy who put in the stent to get a different perspective and I brought the disc of stent procedure. bottom line I was hoping to hear this is normal and it should not progress. I never guessed he would simply say that he saw nothing. btw diet always good, not overweight and exercise ok. also forget to tell this last dr. I wanted disc from second ultrasound cath so cant look at it yet. Am just very frustrated that these guys are all over the place. One thinks I had a small heart attack and the other says no. I dont get it and their both extremely well regarded in the field.
976897 tn?1379171202
You would need clarification from a scan to know for sure if you've had a heart attack, unless it was severe enough to be picked up by an ECG. A nuclear scan would be the best scan for this. You can't tell unless it is backed up by a specific test. For a blockage to increase from 0 to 20% in a few months is certainly very possible. I had one form from 0 to 99% in just three months.
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